The Effect of Hand Holding and Stress Ball Intervention on Pain and Anxiety

Cataract is the main cause of visual impairment and blindness globally and surgery remains the only effective treatment for cataract. Today, it is a common procedure for routine cataract surgery under topical anesthesia. Topical anesthesia is most commonly used because it eliminates potential complications such as optic nerve damage, retrobulbar hemorrhage and ocular muscle injury. However, topical anesthesia does not eliminate pain sensitivity of the iris, zonule and ciliary body during cataract surgery. Moreover, patients may experience discomfort due to manipulation of intraocular structures during surgery. However, patients are awake during surgery to follow the surgeon's instructions, which can lead to anxiety and adverse consequences in physiologic parameters such as tachycardia and hypertension. Patients may move during surgery due to anxiety and pain, and may lose visual function due to bleeding or post-surgical complications such as glaucoma. Therefore, assessing and controlling pain and anxiety during surgery is important for patient comfort and surgical prognosis. Moreover, the management of pain and anxiety during surgery not only reduces patients' anxiety but also increases patient cooperation during surgery. In this context, pharmacological as well as non-pharmacological methods are widely used in the management of pain and anxiety. Although the effects of hand holding and stress ball application on patients' pain, anxiety, satisfaction levels and vital signs in various contexts have been reported, their effects, especially during cataract surgery, have not been sufficiently investigated. Therefore, this study aims to contribute to the existing literature by examining the effects of hand holding and stress ball application on patients' pain, anxiety, satisfaction levels and vital signs during cataract and to provide evidence for the importance of the use of nonpharmacologic methods.

Inclusion criteria

• 18 years and over
• Can understand and speak Turkish
• Clear consciousness, person, place and time oriented
• No hearing and perception problems
• Does not have any mental or neurological disorders that may affect communication (Alzheimer's, dementia, etc.)
• First time cataract surgery
• Those without any psychiatric diagnosis/ treatment (antidepressants, anxiolytics, sedatives, etc.)
• No physical problems in squeezing the stress ball (muscle, joint problems, etc.)
• No analgesic or anesthetic medication 24 hours before the procedure
• Individuals who agree to participate in the study will be included in the study

Exclusion criteria

• Conversion of topical anesthesia to general anesthesia during surgery
• A different story of eye surgery
• Hearing, speech, physical or mental disability
• Pregnancy or possible pregnancy
• Those with malignancy
• Taking an analgesic medication at least 24 hours before the procedure
• People with chronic pain
• History of incomplete or canceled cataract procedures
• Hypertension in the patient (>160/100 mmHg)
• Suppurative/infective/inflammatory skin condition of the hands
• Hypersensitivity to touch
• Patients with contact-transmitted diseases
• Being uncomfortable with hand-holding,
• In case of need for emergency intervention by a physician during or immediately after the procedure
• Failure to perform the stress ball application in accordance with the instruction
• Pre-existing neuropathy (muscle joint problem, stroke, etc.)
• Complications during cataract surgery
• Those who want to leave the study voluntarily
• Termination of the procedure due to deterioration of the patient's general condition during the procedure
• Failure to carry out intervention practices in accordance with the determined protocol (Dropping the stress ball during the procedure, etc.)